Social support and psychological distress before and after childbirth

Abstract

Although there is a substantial literature on the prevalence and determinants of postnatal depression (PND), less attention has been given to the more general distress that women may experience both before and after childbirth. The emphasis in the literature on PND can at least partly be attributed to the dominance of a biomedical model (that stresses conditions internal to the patient) over a psychosocial model (that stresses the social context of experience) in research on maternal mental health. In this paper we combine elements of these two models to explore the social context of well-being for women before and after childbirth. In particular, we grant attention to the influence of support from partners, relatives and friends in predicting levels of antenatal and postnatal distress. Our data derive from a longitudinal survey of 80 women in Auckland, New Zealand, in which we included the Edinburgh Postnatal Depression Scale (EPDS) and measures of perceived social support. In order to focus on distress, we treated the EPDS as a continuous scale rather than using it to focus on “cases” of depression. Interviews were carried out at approximately 36 weeks gestation and 10 weeks post-partum. The ratings for distress were lower postnatally than antenatally and whereas mean ratings for partner support improved between interviews, levels of perceived support from friends and relatives declined. One interpretation of the latter finding is that, at least within the social context of this study, there are higher expectations of informal support in the postnatal period from beyond the household than occurs in actuality. In further analysis we found a strong tendency toward distress among younger and less affluent women who perceive themselves as having weaker social support. This finding supports recent attempts to establish places such as women's centres which generate informal support in the community.